• Precocious puberty: is the medical term for early puberty, also known as central precocious puberty (CPP). It occurs when hormones controlling puberty are released by the brain earlier than usual. This can be caused by psychological difficulties that may impact a child’s emotional development and is much more common in girls than boys. Precocious puberty’s exact cause can not be determined, however, a few cases are related to irregularities of the ovaries or testes, thyroid gland, or other hormone problems. It could also be attributed to genetic conditions and brain tumors, infections, or injury.

For diagnosis, the doctor will review the child’s and her/his family’s medical history, perform a physical exam, run blood tests to measure hormone levels, and X-rays of the hand and wrist to find out the bone age to see if the bones are growing too quickly. Additional testing includes MRI scans to determine any abnormalities) and thyroid testing if the child has shown signs of slow thyroid function like fatigue, increased sensitivity to cold, constipation, a drop in school performance, or pale, dry skin.

It is possible to receive treatment even if there’s no underlying medical condition. The treatment is called GnRH analog therapy which normally consists of a monthly injection of a medication to delay further development. The child will continue the medication until the normal age of puberty is reached. It will take about 16 months on average for puberty to restart. 

There is another treatment without the discomfort and irritation of regular injections. However, it requires a minor surgical procedure of placing an implant under the skin of the inner area of the upper arm. The implant is removed after a year and replaced if it is required.

Delayed Puberty is when puberty occurs late in a boy or girl. Conditions for this include no testicular volume increase by age 14 for boys and no breast development by age 13 for girls. For some, delayed puberty is genetic and will develop normally after being delayed. This is referred to as constitutional delay and is more common for boys. Delays can also be caused by chronic medical conditions like diabetes or cystic fibrosis, genetic conditions, pituitary or thyroid gland problems, ovaries or testes problems, and malnutrition. Girls who routinely exercise may experience delayed puberty in the onset of menstruation of up to one year or more when compared with non-athletes because they have little body fat. Puberty begins when there is a required amount of body fat.

For diagnosis, the doctor will take blood tests (to check hormone levels, look for chromosomal problems, and check for chronic disorders), an X-ray of the left hand and wrist (to estimate bone age), CT scan (to show bones, muscles, fat, and organs), and MRI (to check out the of tissues).

Inherited delayed puberty doesn’t require any treatment. Hormonal therapy treatment is available for some treatments which help to start secondary sexual characteristics to develop. For others, surgery could be done to solve a physical problem.

• Testicles get bigger and the scrotum thins and redden
• Pubic hair starts to appear at the base of the penis

• Penis and testicles grow and the scrotum eventually gets darker 
• Pubic hair gets thicker and curlier
• Underarm hair begins to grow
• Sweating will increase causing body odor
• Breasts might swell moderately temporarily
• “wet dreams” (involuntary ejaculations of semen while sleeping) begin to occur
• Voice cracks (voice gets very deep one moment and very high the next) but finally gets permanently deeper 
• Development of  acne  (skin condition consisting of different types such as whiteheads, blackheads, and pus-filled spots called pustules)
• Growth spurt and get taller with an average of 7 to 8cms annually and become more muscular

• Genitals get adult-sized and pubic hair spreads to the inner thighs
• Facial hair grows
• Height increase gets slower and stops growing completely at around 16 years (but could continue to get more muscular)